Hope you all are having a good week.
My article came out in AGD Impact last week. If you haven't seen it, you can read it here (if you're an AGD member). The feedback has been unbelievable.
I have received e-mails, phone calls, Facebook messages, typed letters, hand-written letters. I even had one dentists photo copy the article and write notes in the margins giving me his feedback. For someone to write me a letter took some work. I mean, my address was not on the article and is not on my website (I am working on this).
It just makes me feel… I don't know what the word is… maybe "worthy." I feel like it is my life’s work. This is something that I think about every day. And from the responses, I am not the only one doing dentistry this way.
“Hi Dr. Gammichia, Just read your article in AGD, and being a former Navy DDS, wanted to say THANK YOU!!!!!!!!!!!! You quoted me in that article!!! I can't tell you how many times I've said similar words to patients and fellow docs!!! I saw so many retiring Navy personnel with large, cuspal coverage amalgams that looked totally awesome after 20 years of service!!! Sure, I placed a few too!!!!!!! Thanks for your "ode to the posterior restorations”, and keep on drilling/filling!!!!!!! Regards, Leslie”
“Ditto to your article in this month's AGD Impact! I have practiced the same way for 14 years. For a long time I would not tell my dentist friends that I like doing large direct composite restorations. As I would follow very successful "giant" composites for years it would give me confidence to continue the same conservative dentistry. So, thank you for going out on a limb and admitting what few of us will! Conservative (cost saving to the patient) dentistry works! Oh, I don't crown every endo tooth either. I have a composite in number 15 endo tooth in my own mouth. My friend who did it years ago thought I was crazy asking her to do that."
“Dear John: I enjoyed your article in the AGD journal. I actually do a lot of similar work as a I work in a city 85 miles from Chicago. I also still do a lot of amalgams. Your work looks really nice. My question is about the restoration in figure F. How do you get the margin to seal or be blood-free in a situation that far subgingival? Do you ever use amalgam? Or do you say "I can't guarantee it but I’ll do my best"? I am curious as I frequently encounter teeth like that. Thanks, Bill"”
Those were three people that looked me up and wrote me via my website. Now a couple emails from a friends:
“Got it! Showed my whole office, and was proud to say I know you!"
“Very well done.”
"John, I hope this email finds all is well with you and your family. Great article in AGD Impact! What you are talking about is not bonding at all, but the difference between relationship-driven dentistry and finance- driven dentistry. I was fortunate enough along my dental journey to listen to individuals tha helped me develop a philosophy of individualistic, patient-driven dentistry. The message of LD Pankey has been lost over the years. He was all about meeting patients’ needs where they were at. It just happened that when he moved to Florida from Kentucky he had a lot more patients with greater financial means and was able to do more comprehensive dentistry.
I find that using the SPIN model for discussing dentistry is the most nonthreatening patient-centered approach. You've probably seen this before. What's going on in the patient’s life? PROBLEM-what's the problem they perceive or I see? IMPLICATION-what's the implication of not doing anything or waiting? NEED-what are the treatment options. Most of the time I have found that if you lay things out in this manner that patients are able to decide what's best for them at the time. I can't tell you how many times I see a patient in hygiene with a large amalgam in a tooth with cracks and say this: this tooth has a large silver filling.
Silver filling is a good filling material, but it does just that, fills in the space where the decay was removed. The strength of the tooth depends on how much enamel is left. Over time we eat and drink hot and cold stuff and the tooth and filling expand and contract. Eventually the tooth starts to develop cracks. In the absence of pain, we have no idea when the tooth will break; it could be today at dinner or another several years. About half the time when teeth break they break in a good way where all we have to do is what we would do preventively. The other half of the time they break into the nerve or below the bone where we have to do a root canal or take the tooth out. So you need to decide, based on how proactive you want to be, whether you want to do something preventively or wait till it breaks.
Some people chose to do treatment; others don’t... no big deal. They made the best decision they could make based on their time, finances, trust in me, etc...The best part is when the tooth eventually breaks they know exactly what needs to be done. The monkey is off our backs.
When you treat patients like you are talking about, they are empowered to make the best decision based on their current circumstances. Dental people tend to get in the mindset that all patients’ number one priority needs to be their teeth. As you know, teeth are very important to a person’s overall health, but not to the extent that a person with limited means needs to spend thousands of dollars on one tooth while other problems exist in their mouth.
So many dentists are struggling now in these times because they don't get this philosophy of practice. Sure they made a butt load of money back in the day, but they’re hurting now. I'll get off my soapbox now. Keep up the good work. Go Gators!
Hope this wasn't boring.
But for those of us who practice this way (and I would think most of you do), this would be a nice little pat on the back. Make you feel less alone. Less like we are on an island of one.
Have a great weekend.